Department of Neurology
Nervous System Diseases | Neurology
Objective: This study aimed to better understand the clinical, electrophysiological, pathological features and prognosis of peripheral nerve involvements in primary immunoglobulin light-chain (AL) amyloidosis.
Methods: We retrospectively reviewed the clinical data of eight AL amyloidosis patients with peripheral neuropathy as the initial presentation including clinical features, histopathological findings and treatment.
Results: There were seven males and one female aged from 52 to 66 years. Initial symptoms included symmetrical lower extremity numbness, lower extremity pain and carpal tunnel syndrome. Seven patients suffered from severe pain and required pain management. Six patients had predominant autonomic dysfunction. Six patients had cardiac involvement, and one patient had renal involvement. Monoclonal proteins were found in all patients, with IgA lambda in one, IgG lambda in two, lambda alone in three, kappa alone in one and IgM kappa in one. Sural nerve biopsies were performed in 7 cases, all of which showed amyloid deposition in the endoneurium (in the perivascular region in some cases), in addition to moderate to severe myelinated fiber loss with axonal degeneration. Six patients were treated with combined chemotherapy. In three patients who began chemotherapy earlier (6-10 months after onset), two achieved a hematological complete response, and one achieved a partial response. three patients who had delayed chemotherapy (36 months after onset) died between 5 and 12 months after diagnosis.
Conclusion: Early recognition of AL amyloidosis with peripheral neuropathy as the initial symptom is very important. Nerve biopsy can help to make the diagnosis. Early diagnosis and chemotherapy are critical to achieve better outcomes.
chemotherapy, nerve biopsy, outcome, peripheral neuropathy, primary light chain amyloidosis
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Copyright © 2021 Qian, Qin, Shen, Guan, Ren, Zhao, Guan, Zhou, Peng, Li and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
DOI of Published Version
Qian M, Qin L, Shen K, Guan H, Ren H, Zhao Y, Guan Y, Zhou D, Peng B, Li J, Chen L. Light-Chain Amyloidosis With Peripheral Neuropathy as an Initial Presentation. Front Neurol. 2021 Sep 28;12:707134. doi: 10.3389/fneur.2021.707134. PMID: 34650504; PMCID: PMC8505956. Link to article on publisher's site
Frontiers in neurology
Qian M, Qin L, Shen K, Guan H, Ren H, Zhao Y, Guan Y, Zhou D, Peng B, Li J, Chen L. (2021). Light-Chain Amyloidosis With Peripheral Neuropathy as an Initial Presentation. Open Access Publications by UMass Chan Authors. https://doi.org/10.3389/fneur.2021.707134. Retrieved from https://escholarship.umassmed.edu/oapubs/4940
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